Stigma, and factors associated with experiencing stigma, while visiting health-care services among samples of people who use illegal drugs in Australia

Rachel Sutherland; Cate King; Antonia Karlsson; Carla Treloar; Timothy Broady; Udesha Chandrasena; Caroline Salom; Paul Dietze; Amy Peacock

doi:10.1111/dar.13846

Stigma, and factors associated with experiencing stigma, while visiting health-care services among samples of people who use illegal drugs in Australia

Drug Alcohol Rev. 2024 Apr 21. doi: 10.1111/dar.13846. Online ahead of print.

Authors

Rachel Sutherland¹, Cate King¹, Antonia Karlsson¹, Carla Treloar², Timothy Broady², Udesha Chandrasena¹, Caroline Salom^{1

3}, Paul Dietze^{1

4

5

6}, Amy Peacock^{1

7}

Affiliations

¹ National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.
² Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.
³ Institute for Social Science Research, The University of Queensland, Brisbane, Australia.
⁴ Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia.
⁵ National Drug Research Institute, Melbourne, Australia.
⁶ Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
⁷ School of Psychology, University of Tasmania, Hobart, Australia.

PMID: 38644679
DOI: 10.1111/dar.13846

Abstract

Introduction: People who inject drugs experience stigma across multiple settings, including when accessing health-care services, however, comparatively little is known about experiences of stigma towards other groups of people who use illegal drugs. This paper examines experience of, and factors associated with, stigma among two samples of people who use illegal drugs when visiting both specialist alcohol and other drug (AOD) and general health-care services.

Methods: Australians who regularly (i.e., ≥monthly) inject drugs (n = 879; illicit drug reporting system [IDRS]) or use ecstasy and/or other illegal stimulants (n = 700; ecstasy and related drugs reporting system [EDRS]) were surveyed between April and July 2022 about past 6-month experience of stigma in the above services. Multi-variable regression analyses were performed to determine the socio-demographic, drug use and health factors associated with stigma.

Results: Experiences of stigma in general health-care services were more common among IDRS (40%) than EDRS (24%; p < 0.001) participants, however, experiences were comparable in specialist AOD health-care settings (22% and 20%, respectively; p = 0.687). Gender identity and experiencing high psychological distress were associated with experiencing stigma across both samples. Past-year overdose was associated with experiencing stigma among the IDRS sample, while unstable housing and incomplete high school education were associated with experiencing stigma in the EDRS sample.

Discussion and conclusions: Experiences of stigma when accessing health-care services are relatively common across different populations of people who use illegal drugs. Our findings highlight the multiple and intersecting dimensions of stigma and provide further support for recent calls for a universal precautions approach to stigma in health care.

Keywords: discrimination; health care; people who inject drugs; people who use drugs; stigma.

Grants and funding

Department of Health and Aged Care, Australian Government